Personalized Medicine and The Pharmacist

Although personalized medicine holds the promise of revolutionary safer, more effective treatments, one must also consider possible pitfalls of tailoring designer drugs for certain segments of the population. The information afforded to clinicians through personalized medicine would be invaluable; identifying the best possible medication for an individual without a trial and error process will undoubtedly save both time and money for patients and our health care system as a whole. But what will drug companies do with this information? Big pharma is notorious for guiding drug development by profits (e.g. me too drugs), rather than continuously producing new, innovative drugs that could truly help patients. One would hope that the birth of personalized medicine, would be accompanied by equal advancements in drugs for the population as a whole. However, based on their track record, it would not be unreasonable to fear that drug companies will base their research on the most lucrative segments of the population, while neglecting those whose genetic makeup makes it harder to find an ideal treatment. Furthermore, coverage could begin to be determined based on what medications should work for patients. Patients who have been stable on a medication for an extended period of time could have their coverage cut if our interpretation of their genes suggests that it is not a cost-effective choice for them. These factors could create “underprivileged” phenotypes who have less new medications to choose from, or less coverage for drugs that are already available.
Despite the many positive opportunities for patients, there are potential pitfalls to the implementation personalized medicine as well. Pharmacists, with their expertise in pharmacogenomics, are in an excellent position to invigilate this process and to ensure that patients have equal access to optimal therapies regardless of their genetics. – KC

Meals can be custom-made at restaurants because the customer may have allergies or is a vegetarian. Now think about extending that concept into designing a medication therapy specifically for one patient. The idea of personalized medicine revolves around the heightened ability to tailor a treatment option according to the patients’ genes. The ideal outcome is being able to catch potential adverse drug reactions before administration of the medication and ultimately increase the overall effectiveness of the drug therapy. However, as personalized medicine is slowly being developed, there still remains various factors that may hinder the process of bringing the concept to general practice.

By genotyping a patient’s DNA, trained pharmacists with the help of lab technicians are able to examine the appropriateness of certain medications even before giving it to the patient. This would help greatly reduce the need for trial and error, thereby minimizing the risk of side effects and shorten the time required to correct ineffective treatment. The fundamental principle of personalized medicine appears to be promising, but the drawbacks and barriers should also be carefully considered.

When looking at the practicality of personalized medicine in the community, the chances of having a variant allele or mutation in a single gene in a pool of wild type individuals are quite rare. Consequently, the usefulness of this concept of tailoring medications may not be of great interest to pharmaceutical companies who look toward making drugs that are safe and effective for a larger population. Furthermore, the process involved in decoding a patient’s genotype and then analyzing possible mutations and variants is a time-consuming process for pharmacists and lab technicians alike. This would then come down to how these professionals should manage their time from other duties, as well as the method of reinbursement for their work.

Personalized medicine is a prospective beginning to taking advantage of new understandings of the human genome and cutting-edge technology in science. However, it is essential to look at the practicality of the concept and how it can extend its use to benefit not just a small group of patients. Pharmacists being the central expert in medication use, can serve as one of the leaders in developing this new area of patient-orientated care. —Ying (Joane) Tang

Orphaned illnesses can sometimes be neglected in pharmacogenetic research, where funds are often doled to find cures for illnesses affecting large populations. The ethics of this matter comes down to “quantity of treatment outcomes” rather than improving the quality of life of select individuals, as research companies try to maximize the number of people who can benefit from treatment. Some rare genetic, fatal illnesses afflict only a few in a million, and these patients are unfortunately unrepresented in the research sector where pooling billions and billions of dollars for a potential miracle cure that would only benefit a select number of individuals would be unlikely. These patients find comfort instead in online chat rooms where another patient from halfway across the world might happen to share the same genetic point mutation as them, and through collective blogging, derive meaning through their chronic illness experience.

This points to the idea of striking a balance between social support and biomedical treatment. The term “personalized medicine” conveys a sense of comfort  and emotional support for patients, but for patients who know nothing about the molecular workings of DNA and gene-directed therapy, or what we can call the “scientific connotation” of personalization, this term might only be illusory. Educating the public about what personalized medicine really is, through an introduction to the basics of DNA and genetics, would dispel these myths for patients who may otherwise feel deceived or disappointed about the treatment they actually receive. At the same time, social support for rare genetic illnesses that remain unrepresented in research for a cure would be greatly appreciated. As pharmacists, we can certainly seek a balance between the two connotations of “personalized medicine” – the knowledge behind its technology, and the empathy we exude in caring for our patients. -GC

Ethical issues regarding personalized medicine.
Personalized medicine has many limitations and challenges regarding policy (ie. how to implement new technologies) and science problems (technical problems). Although it’s probably going to be a challenge to come up with an optimal solution that satisfies many people, I think that these can be resolved by proposing a solution and considering the appropriateness and reasoning. But ethical issues are very tricky in nature in that there’s a dilemma and both sides have pros and cons for justification.
1. Protection of patient privacy is going to be the most important and challenging thing that must be done for individualized medicine. Everybody agrees that patients have the right to keep their health information from other people but how far does that right extend? For example, personalized medicine facility may have collected information regarding what diseases one has (or at risk of having those diseases) based on one’s genotype and gene expression. How do we keep that information private and how do we determine the extent of applying that knowledge to medical procedures such as diagnosis and profiling? Is it okay for that individual to have automatic access to all his genetic information once it has been decoded? What about privacy from other family members? Once one learns of his/her genetic risk of a disease, he/she may infer relative’s risks. Is that fine?
2. Cost issues are also a significant ethical issue in the world of personalized medicine. Many people do not have health insurances (in the case of US) or they have insurances that only cover the basic things. How do we provide access to personalized medicine to everybody? It’s probably unlikely for personalized care to be equally accessible to everybody due to this problem. Provision of this type of care will likely to be stratified similar to US’s traditional medical care and universal access is denied. In that case, is it right that due to cost issues, some people have more comprehensive information about their genetic make-up, while others have limited amount of information they can get access to? – TK